| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $67.59 | $67.59 | $8,500.00 | |
Aetna
| Professional | $61.49 | $94.86 | $120.00 | |
Medica
| Facility | $67.59 | $116.15 | $174.17 | |
Medica
| Professional | $99.64 | $167.42 | $271.72 | |
United
| Professional | $104.24 | $167.42 | $198.06 |